<html>

<head>
<title>ADD</title>
<link type="text/css" href="jquery-ui-1.8.14.custom/css/ui-lightness/jquery-ui-1.8.14.custom.css" rel="Stylesheet" />	
<script type="text/javascript" src="jquery-1.6.2.min.js"></script>
<script type="text/javascript" src="jquery-ui-1.8.14.custom/js/jquery-ui-1.8.14.custom.min.js"></script>
<style type="text/css">
<!--
.style1 {
	color: #006600
}
.style2 {
	color: #FFFFFF;
	font-weight: bold;
}
-->
</style>
</head>
<body bgcolor="#D5FCCD">
<script language="javascript">
function fncSubmit()
{
if(document.form1.id.value == "")
	{
	alert('Please input Id');
		document.form1.name.focus();
		return false;
	}
if(document.form1.name.value == "")
	{
		alert('Please input Name');
		document.form1.name.focus();
		return false;
	}
  
if(document.form1.surname.value == "")
	{
		alert('Please input Surname');
		document.form1.surname.focus();       
		return false;
	}	  
if(document.form1.birthdate.value == "")
	{
		alert('Please input Birth date');
		document.form1.birthdate.focus();       
		return false;
	}	
if(document.form1.bloodgroup.value == "")
	{
		alert('Please input Blood group');
		document.form1.bloodgroup.focus();       
		return false;
	}
if(document.form1.age.value == "")
	{
		alert('Please input Age');
		document.form1.age.focus();       
		return false;
	}
if(document.form1.gender.value == "")
	{
		alert('Please input Gender');
		document.form1.gender.focus();       
		return false;
	}
if(document.form1.doctorid.value == "")
	{
		alert('Please input Doctor id');
		document.form1.doctorid.focus();       
		return false;
	}	
	document.form1.submit();
}

</script>
<br/>
<br/>
<center><h1 class="style1">ADD PATIENT</h1>
</center>
<br/>
<center><table border=3 bordercolor="#99CC33">
<tr><td width="300" bgcolor="#CCCCCC">

<br>
<form action="add-patients.php" method="post" name="form1" onSubmit="JavaScript:return fncSubmit();">
	  <strong>ID:	  </strong>
	  <input type="text" name="id" />
	<br>
	<br/>
	<strong>NAME:</strong> 
	<input type="text" name="name" />
	<br>
	<br/>
	<strong>SURNAME:</strong> 
	<input type="text" name="surname" />
	<br>
	<br/>
	<strong>BIRTHDATE:</strong> 
	<input type="text" name="birthdate" id="datepicker"/>
	<br>
	<br>
	<span class="style2">Format options:</span> 
	  <select id="format">
	    <option value="dd/mm/yy">Default - dd/mm/yy</option>
	    <option value="dd-M-yy">ISO 8601 - dd-M-yy</option>
	      </select>
      <strong><br>
      <br>
      BLOOD GROUP: </strong>
<select name="bloodgroup">
			<option selected value=''>Select Blood group</option>
			<option value='O'>O</option>
			<option value='A'>A</option>
			<option value='B'>B</option>
			<option value='AB'>AB</option>
		</select>
	<br>
	<br/>
	<strong>AGE:</strong> 
	<input type="text" name="age" />
	<br>
	<br/>
	<strong>GENDER:</strong>
	<select name="gender">
			<option selected value=''>Select Gender</option>
			<option value='F'>Female</option>
			<option value='M'>Male</option>
		</select>
	<br>
	<br/>


	<strong>DOCTOR ID:	</strong>
	<input type="text" name="doctorid" />
	<br>
	<br/>
	<center><input type="submit" />
	  <br>
	  <br>
	</center>
</form>

</td></tr>
</table>

<div align="center"></div>
<script>
	$(function() {
		$( "#datepicker" ).datepicker();
		$( "#format" ).change(function() {
			$( "#datepicker" ).datepicker( "option", "dateFormat", $( this ).val() );
		});
	});
	</script>
</body>
</html>